[Etiology and treatment of sterility due to azoospermia]. / Etiologie et traitement de la stérilité due à une azoospermie.

Azoospermia can be classified according to the serum level of FSH into obstructive (OA) or non-obstructive (NOA) azoospermia. It can also be due to a lack of gonadotrophins. In the latter case the administration of FSH and HCG can normalize the sperm production. In the other cases ICSI must be performed. In OA sperm can be retrieved using percutaneous epididymal aspiration or testicular fine needle aspiration in case of failure of vasovasostomy or epididymovasostomy. In NOA or spermatogenic arrest, focal spermatogenesis can be observed in 40 to 50% of cases using repeated testis biopsies, allowing to perform ICSI. Although the risk of malformation in children born after ICSI is not increased there is an increased risk to transmit genetic abnormalities in case of NOA (such as the rate of sex chromosome, or microdeletions of the Y chromosome) and in case of congenital OA (mutations of the cystic fibrosis gene).

[Treatment of male sterility by in vitro fertilization]. / Traitement de la stérilité masculine par fécondation in vitro.

A pregnancy obtained through in vitro fertilization in a case of male sterility due to oligospermia with high FSH is reported. After a review of controlled studies dealing with classical andrological treatments (repair of varicocele, treatment of prostatitis and immunological sterility), the place of in vitro fertilization is evaluated in relation to intrauterine insemination using active sperm.

Mating is random.

Human leukocyte antigen (HLA) typing was undertaken in 151 unrelated blood donors and in 35 normal couples having at least two living children. We compared observed and expected sharing of HLA antigens at four loci in normal couples. We also compared the observed sharing in couples with the expected sharing in unrelated blood donors if taken two by two and with the sharing observed after 1000 "synthetic matings" of normal couples. No statistically significant difference in HLA sharing appeared between these groups. Furthermore no differences were observed in the probabilities of sharing individual HLA antigens among the different groups. We thus conclude that the observed HLA sharing in normal couples is governed by chance alone and that mating is random in our population.

The value of the postcoital test according to etiology and outcome on infertility.

Post coital test (PCT) has been analysed in 150 women divided into 3 groups of 50 patients consulting for infertility. In group I, women achieved pregnancy whereas in group II, women were not pregnant during the same period of observation and had a sterility of non-tubal origin. Group II included women with infertility due to tubal factor. The results of the PCT were not significantly different in group I and in group III. More than 50% of the women had a good PCT (more than 7 motile sperms/hpf). In women of group II, 75% had an inconclusive test (less that 5 sperms/hpf) or negative tests, significantly different from the % observed in group I (44%). Inconclusive PCT in group II were due to anovulatory cycles in 50% of the cases and to cervical infection in 25% of the cases. Status post-cauterization of the cervix, anatomical or immunological problems and sexual dysfunctions accounted for the remaining cases. Prognostic significance of the PCT is discussed according to these results.

[Reproduction and immune factors in the male]. / Reproduction et facteurs immunitaires chez l'homme.

Sperm antigenicity is demonstrated by the formation of sperm antibodies following vasectomy and by the possible occurrence of hypersensitivity reactions in women to seminal fluid. It may be that immunosuppressor factors in seminal plasma, as well as certain placental hormones, could explain the fact that sperm are not rejected immunologically in the female genital tract. The role of these different immune factors in male infertility and in the pathogenesis of AIDS is discussed.

[Reproduction and immune factors in women. Pregnancy, habitual abortion and HLA histocompatibility]. / Reproduction et facteurs immunitaires chez la femme. Grossesse, avortements habituels et histocompatibilité HLA.

Immune tolerance of the mother towards the fetus, which is like an allograft, may be explained partially by the presence of immunosupressor factors produced by the placenta. The maternal production of antibodies against trophoblastic antigens would seem equally necessary to prevent the fetus being rejected by cytotoxic maternal lymphocytes. Where there is marked histocompatibility between partners the protecting antibodies are absent and that gives rise to repeated abortions. This hypothesis is discussed as well as the rationale of treatments that are aimed at increasing maternal production of protective antibodies in cases of habitual abortion.

[Dinoprostone or sulprostone. Comparison of 2 analogs of prostaglandin for the interruption of pregnancy in the 2nd trimester]. / Dinoproston ou sulproston? Comparaison de deux analogues de prostaglandine pour interrompre la grossesse au deuxième trimestre.

We have reviewed a hundred terminations of pregnancy in the second trimester carried out in Geneva, using repeated intra-muscular injections of prostaglandin analogues. We have compared the efficacy and the importance of the side effects of two of these analogues, namely Dinoproston ( Prostin F2 alpha) and Sulproston ( Nalador 500). The induction-delivery interval was identically the same. On the other hand Sulproston provoked fewer cases of diarrhoea (18%) than Dinoproston (69%).

Pregnancy-associated plasma protein-A (PAPP-A) and immunosuppressive activity in split ejaculates.

Pregnancy-associated plasma protein-A (PAPP-A) and phytohemagglutinin (PHA)-induced lymphocyte transformation were measured in split ejaculates of 17 normal volunteers. The concentration of PAPP-A was identical in both fractions of the ejaculate but the first fraction was twice as immunosuppressive as the second fraction. The origin of PAPP-A in men as well as its possibility of being an immunosuppressor is discussed.

[The influence of oral contraception on the sex life of adolescents (author's transl)]. / Influence de la contraception orale sur la vie sexuelle des adolescentes.

PIP: 361 adolescent girls were prescribed contraceptives between 1978-1981 and were then questioned about their social and sexual lives. The request for contraceptives is being made at a younger age (mean age 15.9 years) than was the case 5 years ago. This is a situation of which few parents are aware; only 23% of the fathers and 36% of the mothers were informed. 27% of the girls come to the 1st consultation as virgins; and among the others, 25% had the 1st sexual intercourse before they were 15 years of age. In 60% of the cases, this experience is preceded by a flirt of more than 3 months. The security procured by oral contraception does not lead to a frequent change of partners. During the 12 months following the 1st prescription, 3/4 of the adolescents remained faithful to their boyfriends, whatever the number of previous partners they had had. (author's)^ieng

[Maturation of the cervix by prostaglandins before inducing termination of pregnancy, in the first trimester (author's transl)]. / Maturation cervicale par prostaglandines avant les interruptions volontaires de grossesses.

A new technique for instilling the gel of PGF2 alpha into the endocervix is presented. The study is concerned with 100 therapeutic terminations of pregnancy by dilatation and suction carried out in the first trimester of pregnancy. The efficacy of PGF2 alpha gel is compared with that for tablets of PGE2 and a placebo group. Softening of the cervix was evaluated using a tocodynamometer. PFG2 alpha gel often gives remarkable results, but the response to treatment is unpredictable. Secondary effects, and in particular digestive effects, occur frequently but are always easily controlled.